Bladder with improved construction

ABSTRACT

The invention relates to a bladder and incorporation of a bladder in a shoe for cushioning a wearer&#39;s foot having an outsole, an upper, and a bladder adapted to receive the foot and being placed between the outsole and the upper. The bladder further has a first chamber and a second chamber, where the first chamber is in contact with the second chamber for providing continuous cushioning. The bladder is also removably placed between the upper and outsole. In other aspects of the invention, the bladder is integrally placed between the upper and outsole.

FIELD OF THE INVENTION

The invention relates to structures employed in shoes, protectiveequipment, and the like, for absorbing and dispersing energy.

BACKGROUND OF THE INVENTION

Structures for absorbing and dispersing mechanical energy are usuallyincorporated into shoes, sporting goods, clothing, protective equipment,vehicles, and the like to provide user comfort and safety. Suchstructures typically absorb and distribute kinetic energy to preventdamage or discomfort resulting from impacts. These structures mayinclude football helmets, crash helmets, ballistic vests, and the liketo minimize damage from energetic impacts.

Some energy absorbing and dispersing structures may be fabricated frompolymeric foam materials of either the open or closed cell type. Inother instances, such structures can be bodies of fibrous materials. Yetother instances may employ springs, pistons, and the like to be used asenergy dispersing devices.

Shoes that typically employ a foam material often have a higher degreeof resiliency. This can be accomplished by utilizing a relatively stiffopen cell foam structure, or by going to a closed cell foam, or othersuch structure which possibly includes sealed air pockets. In eitherinstance, the stiffer sole may provide adequate cushioning for highshock levels but is often rigid under low shock conditions, which couldcompromise comfort.

Some shoes known in the art may involve a variety of inflation devicesdisposed at different locations. For instance, previous shoearrangements may have included soles that can be inflated at the arch toprovide support. Other shoes typically have sealed inflated chambersdisposed within the soles in order to increase vertical bounce. Suchprior art shoes may not allow for selective adjustment of the pressurein the bladder chambers and may result in uneven air distribution in thesole of the shoe.

Moreover, if an impact force applied to such a structure exceeds itsoperational range, the structure may bottom out. In some instances, thestructure will undergo irreversible break down. Bottoming out oftenoccurs when a structure can absorb no more energy and ceases to provideany protection. For example, soles of shoes often include energyabsorbing structures fabricated from open cell foam materials. However,when high levels of force are applied to these materials, as for examplewhen the wearer jumps, runs, or stumbles, the cellular structure of thematerial typically flattens, and the innersole may bottom out allowing ajarring shock to be transmitted to a wearer's foot. Hence, the inflationdevice may be acceptable under low shock conditions but unacceptable,due to the bottoming out, under high shock conditions.

This bottoming out can be alleviated by providing a thicker body of foammaterial. However, such increases in thickness are generallyunacceptable in footwear due to increase in bulk and instability.Furthermore, using a thicker body of foam in the sole of a shoe usuallyproduces discomfort and fatigue.

Pumps in some prior art shoes have typically been either externallyconnectable to the shoe's air chambers or positioned in low stress areason the upper portion of the shoe, such as in the tongue or on the backof the heel. For externally connectable pumps, the pump must beretrieved whenever inflation is desired. Pumps positioned on the upperportion possibly add bulk to the shoe and could limit agility. Suchpumps also tend to inhibit aesthetic choices in shoe design.

U.S. Pat. No. 4,217,705 to Donzis appears to relate to an air filledchamber created by a top sheet and a bottom sheet sealed together aroundthe entire periphery. The top and bottom sheets may be sealed togetherin select areas within the perimeter of the periphery to create a seriesof compartments that are in fluid connection with one another. Becausethe compartments may be in fluid communication with one another, asingle type of fluid seems to be used to fill all compartments.

U.S. Pat. No. 4,446,634 to Johnson, U.S. Pat. No. 5,987,781 to Pavisi,U.S. Pat. No. 5,813,142 to Demon, U.S. Pat. No. 6,519,873 to Buttigieg,and U.S. Pat. No. 6,725,573 to Doyle appear to relate to a shoe with oneor more chambers where all chambers have a single type of fluidcontained within the chambers. In some of these references that havemore than one chamber, the chambers seem to be spaced apart from oneanother.

What is desired, therefore, is a shoe with a cushioning device that hasimproved comfort and safety. Another desire is a shoe with a cushioningdevice that resists bottoming out. A further desire is a shoe with acushioning device that permits adjustment to the cushioning device sothat the shoe remains flexible during low shock conditions and issufficiently rigid during high shock conditions.

SUMMARY Of THE INVENTION

It is, therefore, an object of the invention to provide a shoe that hasan improved cushioning device.

Another object is a cushioning device that allows its physicalproperties to be varied in accordance with the intended use of the shoe.

A further object of the invention is to provide a cushioning device thatincludes separable internal chambers so that various fluids may beplaced inside the chambers.

Yet another object is a cushioning device that provides continuouscushioning during transition from one chamber to a next chamber.

A still further object is a cushioning device that controls a fluid'smovement during compression of the cushioning device so that the area ofthe cushioning device experiencing the compression resists completedecompression.

These and other objects are achieved by a shoe for cushioning a wearer'sfoot having an outsole, an upper, and a bladder adapted to receive thefoot and being placed between the outsole and the upper. The bladderfurther has a first chamber and a second chamber, where the firstchamber is in contact with the second chamber for providing continuouscushioning. The bladder is also removably placed between the upper andoutsole. In other aspects of the invention, the bladder is integrallyplaced between the upper and outsole.

In some embodiments, the shoe has a first filler removably placed withinthe first chamber and the first filler includes a property selected fromthe group consisting of a user determined density, a user determinedvolume, a user determined weight, a user determined texture, a userdetermined consistency, and combinations thereof.

In other embodiments, the shoe has a baffle placed within the firstchamber. In further embodiments, a socklining is placed on top of thebladder for receiving a wearer's foot.

In yet another embodiment, a distance between the first and secondchambers is fixed. In some of these embodiments, the first chamber isadjacent to the second chamber.

In some other embodiments, a plurality of chambers and a plurality offillers are provided, each filler corresponding to a chamber.

In another aspect of the invention, a shoe for cushioning a wearer'sfoot includes an outsole, an upper, and a bladder adapted to receive thefoot and being placed between the outsole and the upper. The bladderalso includes a first chamber and a second chamber, where the firstchamber is adjacent to the second chamber for continuous cushioning andwhere the first chamber includes a first filler that is different than asecond filler that is within the second chamber.

In some embodiments, a plurality of chambers and a plurality of fillersare provided, each filler corresponding to a chamber and where eachfiller is different from a next filler.

In other embodiments, the bladder includes a top sheet and a bottomsheet, where the top and bottom sheets are sealed together along aperiphery of the top and bottom sheets. In some of these embodiments,the bladder includes a baffle for inhibiting movement of a first filler.

The baffle is a contact point between the top and bottom sheets withinthe periphery of the top and bottom sheets. In another embodiment, thebaffle includes a wall with a top end connected to the top sheet and abottom end connected to the bottom sheet. In addition to or instead ofthe above, the baffle is a permeable membrane.

In a more specific aspect of the invention, a bladder includes a topsheet having a periphery, a bottom sheet having a periphery, the topsheet being in contact with the bottom sheet along the peripheries ofthe top and bottom sheets, and where the top sheet is in contact withthe bottom sheet in a localized area for defining a first chamber and asecond chamber.

In some embodiments, the localized area extends across the top andbottom sheets from one side to an opposite side. Moreover, the firstchamber includes an optional baffle for inhibiting movement of the firstfiller and/or the second filler. In some of these embodiments, thebaffle is a contact point between the top and bottom sheets within theperipheries.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 depicts the shoe in accordance with the invention.

FIG. 2 more particularly depicts the bladder shown in FIG. 1.

FIG. 3 depicts the bladder of FIG. 1 being compressed during usage.

FIGS. 4 a and 4 b shows the inside of the bladder shown in FIG. 1.

FIGS. 5 a-5 d show various applications of a baffle placed within thebladder of FIG. 1.

FIG. 6 a-6 c depicts another embodiment of the bladder shown in FIG. 1.

FIG. 7 depicts an application of the bladder shown in FIG. 1 in a shoe.

FIG. 8 depicts another application of the bladder shown in FIG. 1 in ashoe.

FIG. 9 depicts another application of the bladder shown in FIG. 1 in ashoe.

FIG. 10 depicts another application of the bladder shown in FIG. 1 in ashoe.

DETAILED DESCRIPTION

FIG. 1 depicts shoe 30 in accordance with the invention. Shoe 30includes outsole 40, upper 50, and bladder 60 placed between outsole 40and upper 60 for cushioning and/or supporting a user's foot. Forenhanced comfort, socklining 41 is optionally placed on top of bladder60 for receiving a user's foot. As more particularly depicted in FIG. 2,bladder 60 includes at least one chamber for containing a filler. Asshown, bladder 60 includes first chamber 62, first filler 72, secondchamber 64, second filler 74, third chamber 66, and third filler 76.

It is understood that although 3 chambers are shown, bladder 60 mayinclude any number of chambers or a plurality of chambers, as well as afiller for each chamber including a plurality of fillers. The morechambers, the more bladder 60 may be filled with differing fillers ofdiffering softness, density, or comfort in various areas of bladder 60.It is understood that the shape of a chamber is not germane to theinvention.

In some embodiments, bladder 60 is removably placed between outsole 40and upper 50 so that other bladders of varying characteristics may beutilized. This is advantageous when shoe 30 is used for different sportsor in different environments and bladder 60 may be interchanged withanother bladder rather than altering bladder 60. This reduces timeespecially if the process is to be repeated. In further embodiments,bladder 60 is integrally placed between outsole 40 and upper 50. Thisreduces the likelihood of bladder 60 from becoming accidentallydislodged.

For purposes of simplicity, first filler 72 will be described but itshould be known that second filler 74, third filler 76, and a pluralityof fillers all include the same limitations as first filler 72.Likewise, although first chamber 62 is described in detail below, it isunderstood that second chamber 74, third chamber 76, and a plurality ofchambers all include the same limitations as first chamber 62. Moreover,although each filler is capable of being different than a next filler,it is not required. In some embodiments, two fillers are the same but athird filler is different. In other embodiments, all three fillers aredifferent.

First filler 72 may be any solid, powder, liquid, or gas that may beplaced within first chamber 62. The purpose of first filler 72 is tovary support, cushioning, and/or comfort to the wearer's foot dependingupon the wearer's preferences. Hence, a density, volume, weight,texture, consistency, and any other property of the filler may be variedor user determined in any combination. For example, if a particularliquid does not provide adequate support, a different liquid may beutilized, where the second liquid may have a different density,buoyancy, texture, or weight. Therefore, when compressed by the foot,the wearer will experience the particular sensation, support,cushioning, or comfort unique to the particular filler. When a filler isdefined to be different than a next filler, it means any of theproperties or characteristics, or a combination for the properties orcharacteristics, listed herein is varied or changed.

In some instances where filler 72 is of a low viscosity, such as withsome liquids, or where filler 72 is easily compressed, such as with somegases, first chamber 62 may be depressed to the point where there is nofiller 72 in one part of first chamber 62, in which case little or nocushioning, support, or comfort may be derived from first filler 72.This may be due to compression of first chamber 62 from walking orrunning by a wearer.

During walking, the wearer typically strikes the heel first and thenrolls to the middle of the foot and finally to the balls or toes of thefoot. During this rolling, or gradual transition, from heel to toe, achamber may be compressed on first part 44 and not second part 46, andvice versa (as shown in FIG. 3). This problem is exacerbated if firstfiller 72 is compressible or has a low viscosity.

As shown in FIG. 4 a, baffle 90 is any structure placed within anychamber for inhibiting movement of a filler. Baffle 90 is optional. Insome embodiments, baffle 90 is placed in some chambers but not otherchambers. For purposes of simplicity, baffle 90 will be described asshown within first chamber 62. However, any other chamber may alsoinclude baffle 90. In some embodiments, baffle 90 is a wall connected toroof 82 and floor 84 of first chamber 62. Baffle 90 may be angularlyattached to roof 82 and floor 84 or attached to roof 82 and floor 84 atright angles, depending upon the resistance desired for inhibitingmovement of the filler. In other embodiments, baffle 80 is attached toeither roof 82 or floor 84 but not both. In simpler embodiments, baffler80 is merely a contact point between roof 82 and floor 84 without anywalls or structure to connect roof 82 with floor 84, which may beineffective if the walls or structures become dislodged. In thisfashion, melting or cementing roof 82 to floor 84 is less costly andeasier to achieve the purpose of inhibiting movement of a filler thanconnecting a wall to roof 82 and floor 84. Moreover, melting orcementing roof 82 and floor 84 together to form baffle 90 can be done inthe same operation as forming a chamber, which connects or seals aperiphery of roof 82 and floor 84 together.

It is understood baffle 90 may extend partially or entirely across firstchamber 62 from left side 86 to right side 88 or front side 87 to backside 89. Additionally, baffle 90 may be placed at an angle relative tothe longitudinal axis of shoe 34, as shown more clearly in FIG. 4 b (atop view of chamber 62 and baffle 90). In order to vary the resistanceto filler for inhibiting the movement of filler, the angle of baffle 90relative to the longitudinal axis may be varied to inhibit more or lessof the filler's movement. Moreover, baffle 90 may be placed at adifferent angle than a next baffle 91. Similarly, baffle 90 may beattached to top sheet 82 and bottom sheet 84 but baffle 91 may beattached only to bottom sheet 84. Also, the angle at which baffle isattached to roof 82 may vary from that of baffle 91. Still further,baffle 90 may extend at different lengths across chamber 62 than nextbaffle 91, whether it be from left side 86 to right side 88 and/or fromfront side 87 to back side 89.

In some embodiments of the invention, and in addition to or instead ofthe above description for baffle 90, baffle 90 includes permeablemembrane 93. Membrane 93 is any thin, pliable sheet that acts like afilter that permits filler 72 to pass through but controls or slows theflow of filler 72, which results in a controlled or slowed depression,or compression, of bladder 60 when a user's foot presses down uponbladder 60. In some embodiments, permeable membrane 93 permits parts offiller 72, such as molecules containing Carbon, to pass through but mayinhibit other parts of filler 72, such as molecules not containingCarbon, from passing through. This feature would act as, in addition tothe presence of membrane 93 itself, another control to slow the flow offiller 72. FIGS. 5 a-5 d depict various applications of permeablemembrane 93 in first chamber 62.

In this fashion, bladder 60 may be customized in a variety of differentways depending on what change or combination of changes are made to theproperties of the filler. For example, besides changing the filler, avolume of a filler may be increased to enhance comfort or a filler maybe a gel or solid to increase support or act as an orthodic. Moreover,the more chambers in bladder 60, the more adjustments may be made sinceeach chamber may have a different filler with a different volume,density, or feel. Various types of materials for use as a filler includevisco elastic or memory foam to mold to the shape of the user's foot,open and closed cell polyurethane foams, water, oil, helium,polyurethane gel, acrylic polymer gel, and the like. Additionally,baffle 90 further customizes bladder 60 by permitting flow control offiller 72, depending upon the orientation or material of baffle 90and/or next baffle 91.

As shown, bladder 60 extends from toe area 36 to heel area 38 of shoe 30and from left side 37 to right side 39 of shoe 30. Also as shown,membrane 93 extends from toe area 36 to heel area 38 and from left side37 to right side 39. In some embodiments, bladder 60 extends partiallyacross shoe 30. Also, as shown in FIGS. 5B-5D, membrane 93 extendspartially across shoe 30 too.

It is understood that all chambers may be made of the same material andbe the same size. In other embodiments, each chamber is of a differentmaterial than a next chamber. In further embodiments, each chamber is ofa different size than a next chamber.

For example, first chamber 62 may be made of rubber while second chamber64 may be made of a more resilient or elastic material. Differentmaterials may be needed to accommodate different fillers. If firstfiller 72 is a liquid, first chamber 62 would be of a material strongenough to reduce rupture while also being leak resistant. Hence, rubbermay be utilized. If second filler 74 is a gel, second chamber 62 may notnecessitate a material that is particularly leak resistant ifflexibility is more desired. Hence, a stretchable material such as clothor spandex may be utilized to contain a gel. Perhaps a canvas typematerial is desired due to its strength rather that its leak resistance.Therefore, depending upon the type of filler and desired function of thechamber, the material for each chamber may vary or be the same as thenext chamber.

The material of a chamber may also be selected depending upon anydesired or undesired chemical reaction between the filler and thechamber. For example, if a filler contains hydrogen, the materialselected for the chamber may be desired to be free from reaction withhydrogen. In other embodiments, the material may be desired to reactwith hydrogen so that, for example, water may be formed and act as alubricant.

By having at least one chamber (first chamber 62, second chamber 64, andthird chamber 66) in a side by side orientation as shown (see FIG. 2),bladder 60 improves comfort and provides continuous cushioning asbladder 60 transitions from chamber to chamber. This is because thechambers are in such close proximity to one another, and fixed in suchpositions since all chambers are fixedly attached together to formbladder 60, that the cushioning in bladder 60 feels continuous to awearer.

Moreover, each chamber may be filled with a different filler than a nextchamber so that areas of bladder 60 that are subjected to higher stressconditions, such as the heel, may be filled with a filler of higherresistance to compression and areas subjected to lower stress, such asthe arch, may be filled with a filler of higher flexibility. By usingdifferent fillers in different chambers, bladder 60 provides flexibilityin select areas and strength/stability in other areas.

Further, due to baffle 90, a chamber may be less likely to bottom outsince the filler will be impeded from moving completely from one area ofthe chamber to another area of the chamber. In this fashion, baffle 90helps prevent the chamber from bottoming out since there will be fillerin all areas of the chamber, particularly in areas being subjected tostress.

The types of fillers that may be employed are all selected by a user,which may be the wearer or a manufacturer of bladder 60. The userselects a particular filler based on the filler's physical propertiesand the type of cushioning, strength, or rigidity desired as well as theprojected environment in which shoe 30 is used.

As stated above, the filler is selected depending upon a variety ofproperties or characteristics of the filler. Below is table of thevarious properties of each filler. All properties are understood to beapproximate. Polyurethane Gel Foam Water Gel Oil Density .35-.65 .20-.45.96 .50-.75  .85-1.00 (g/cm³) Viscosity 600-800 n/a .89   800-1,200400-600 (cps) Shore 00 40-50 30-40 n/a 50-70 n/a Durometer Weight of≧200 ≧125 ≧100 ≧150 ≧135 Use (lbs)

FIGS. 6 a-6 c depict another embodiment of bladder 60 where wickingfabric 95 is secured to a top of surface of bladder 60. As shown,wicking fabric 95 is integrally attached to first chamber 62, secondchamber 64, and third chamber 66 and where first chamber 62, secondchamber 64, and third chamber 66 are separate from one another, althoughthe spacing between the chambers resembles that of bladder 60 shown inFIG. 1. In the embodiment shown in FIGS. 6 a-6 c, wicking fabric 95 isadhered across the top of bladder 60 and effectively connects firstchamber 62, second chamber 64, and third chamber 66 together. In thisfashion, it would be redundant to further connect first chamber 62,second chamber 64, and third chamber 66 together as shown in FIG. 1 andthen adhere wicking fabric 95 onto bladder 60. However, although firstchamber 62, second chamber 64, and third chamber 66 shown in FIGS. 6 a-6c are initially separate from one another, all three chambers achievethe same advantages of the embodiment shown in FIG. 1 when all areattached to wicking fabric 95. First chamber 62, second chamber 64, andthird chamber 66 may each be independently attached to wicking fabric95.

As shown, first chamber 62, second chamber 64, and third chamber 66 areall made of a solid gel or foam, such as a visco elastic memory foam,where the filler for each chamber and the chamber itself form a singleunit. In other words, first chamber 62, second chamber 64, and thirdchamber 66 do not require a respective filler and, vice versa, thefirst, second, and third fillers do not require a respective chamber tocontain each filler. This embodiment simplifies the invention bycombining each filler together with each respective chamber.

Wicking fabric 95 is any material used to absorb moisture and/or odoraway from the user's foot. Wicking fabric 95 may further include abacteria reducing agent and/or fragrance emitting agent to reduce fungusand help the foot smell better.

In some embodiments, wicking fabric 95 is a two-layered composite havinga cover layer and a foam layer that is hydrophilic with respect to thecover layer, which is operatively joined or connected or bonded orotherwise laminated in any suitable way to the cover layer as by needlepunching, so that the composite material acts to draw or transfermoisture or bodily fluids from and through the cover layer into the foamlayer which acts as a reservoir, to absorb, gel or store and dissipatesuch moisture or bodily fluid as by evaporation from or by washing ofthe composite material. After the moisture or bodily fluid isdissipated, from time to time, the composite material can be reused.However, those skilled in the art will recognize that the compositematerials formed in accordance with the present invention can also bemade of materials so that the composite material can also be disposablerather than reusable.

The foam layer may be first formed by polymerizing an aqueous mixture,having as its principal component one or more sorbents with or withoutvarious additives, with a predetermined quantity of a hydrophilicurethane prepolymer binder so that the polymerization of thepolyurethane foam forms a matrix binder for the one or more sorbents.While the sorbents have been referred to as the principal component, itwill be readily understood by those skilled in the art that the aqueousmixture may consist of various combinations of other components withoutdeparting from the scope of the present invention including absorptivefillers, fibrous materials, including non-woven fiber materials,surfactants, thermoformable acrylic latex emulsions, odor absorbents andbactericides. Further and additional components may include citric acid,rubber particles and thermal phase change particles depending on certainadvantageous and desirable characteristics or functions to be achievedby the composite material.

The characteristics of the sorbent component may be selected so that thevolume, rate of absorption and the retention or gelling of the moistureabsorbed under varying ambient conditions of temperature and pressuremay be optimized for a given composite material being formed. Preferredsorbents adapted for use in the aqueous mixture are primarily superabsorbent polymers available in the commercial marketplace as SAB 800from STOCKHAUSEN, Greensboro, N.C. 27406; as SANWET IM 1000 from HoechstCelanese Corporation, Portsmouth Va. 23703; as ARIDAL 1460 from ChendalCorporation, Palatine, Ill. 60067; and as ARASORB 800F from ArakawaChemical Industries, Limited, Osaka 541, Japan.

These sodium polyacrylate/polyalcohol polymer and co-polymer sorbentsare manufactured and sold in free-flowing, discrete solid particles, inpowder or granular form, and are characterized by the fact that theyhave a propensity for absorbing increasing quantities of aqueous fluid.This would normally lead to the complete solution of the polymers intothe aqueous mixture. However, due to the chemical characteristics of thepolymers and co-polymers, the formation of a gel takes place precludingthe solution of the polymer or co-polymers. Other sorbents includingpolyethylene oxide, sodium carboxymethyl cellulose, and like polymers,desiccants such as silica gel, clays such as bentonite, and the like maybe used as well.

Thus, when an aqueous mixture is metered and mixed with a hydrophilicurethane prepolymer, as more fully described below, the urethaneprepolymer reacts with the water in the aqueous mixture to form ahydrophilic polyurethane foam, and at the same time when a sodiumpolyacrylate sorbent is present, the urethane prepolymer reacts with thesorbent to form a hydrophilic acrylic urethane interpolymer.

The combination of the sorbent with the hydrophilic foam thus formedacts in composite materials of either two larger or multiple layers toabsorb, adsorb and gel the moisture drawn through the cover layer and tocontain and store it so as not to rewet the cover top layer of thelayered composite material. The sorbents thus add hydrophilicity to thefoam layer of the composite materials.

The additives which may be combined in the aqueous mixture with thesorbents are also available in the commercial marketplace.

Thermoformable acrylic latex emulsions are available from Union CarbideCorporation of New York, N.Y., Rohm & Haas, B. F. Goodrich and others.One preferred form of acrylic emulsion is available from Union Carbideunder the trademark “UCAR 154”. As is well known to those or ordinaryskill in the art, latex emulsions are surfactant-stabilized polymeremulsions, and are commonly used as binders for non-woven materials. Thethermoformable latexes form thermoplastic polymer films that are capableof being formed or molded when the film is heated above the glasstransition temperature of the polymer.

Use of acrylic latex emulsions in the foam layer of the presentinvention thus serves as an alternative to the three-layer compositematerials of the present invention wherein the third layer is athermoformable non-woven material bonded to the side of the foam layerremote from the cover layer. The thermoformable acrylic latex emulsionsare incorporated into the foam layer by including the emulsion as partof the aqueous mixture reacted with the hydrophilic urethane prepolymer.The water content of the emulsion reacts with the hydrophilic urethaneprepolymer to form the polyurethane foam when the aqueous mixture andthe urethane prepolymer are reacted together. Thus, the water content ofthe emulsion should be included as part of the water content of theaqueous mixture when calculating the ratio of the aqueous mixture to bereacted with the urethane prepolymer. Those of ordinary skill in the artwill understand that the acrylate component contributed by thethermoformable acrylic latex emulsion is discrete and separate from theacrylate component contributed by the sodium polyacrylic sorbent, whenpresent.

When the foam polymerization is complete, residual water is driven offby drying the foam at a temperature of about 200° F. After bonding ofthe foam layer to cover layer, the thermoformable acrylic latex, whenpresent, permits the forming or molding of the composite by heating thecomposite in a mold or other form at a temperature above the glasstransition temperature of the acrylic latex, typically a temperature ofabout 270° F., after which the composite is cooled and removed from themold or form.

Surfactants useful in the combinations in accordance with the presentinvention are prepared from nonionic polyethylene and polypropyleneoxides such as the BASF surfactant available under the trademark“PLURONIC”.

Odor absorption materials are also well known to those skilled in theart and include, activated carbon, green tea, “ABSENT” (UOP); zinc oxideand the like materials.

Bactericides are provided in the commercial marketplace by a myriad ofsuppliers for controlling bacterial and germ growth. One preferredmaterial is supplied by Lauricidin Co. of Galena, Ill. 61036, under thetrademark “LAURICIDIN”.

Phase change materials are capable of absorbing approximately 100BTU/lb. These materials are described in U.S. Pat. Nos. 4,756,958 and5,254,380.

Other components may be added to the aqueous mixtures, such as citricacid as a buffer for reducing the pH of the water component to increaseloading of the sorbent and the fluid characteristic of the aqueousmixture to facilitate pumping of the aqueous mixture; and ground rubberparticles from tires available from Composite Particles of Allentown,Pa. increase the resiliency and thermal protection of the compositematerial. These will be illustrated in the examples of the aqueousmixture more fully set forth below.

The hydrophilic urethane prepolymer component is also available in thecommercial marketplace. Suitable prepolymers will be readily recognizedby those of ordinary skill in the art and are described in U.S. Pat.Nos. 4,137,200; 4,209,605; 3,805,532; 2,993,013 and general proceduresfor the preparation and formation of such prepolymers can be found inPolyurethane's, Chemistry and Technology by J. H. Saunders and K. C.Frisch published by John Wiley & Sons, New York, N.Y., at Vol. XVI Part2, High Polymer Series, “Foam Systems”, pages 7-26, and “Procedures forthe Preparation of Polymers”, pages 26 et seq.

One preferred form of such prepolymer adapted for use in the presentinvention because of its strong hydrophilic characteristics and itsreasonable price is marketed by Matrix R & D of Dover, N.H. as TDI/PEGUrethane Prepolymer under the trademark “BIPOL”. These products arepolyether urethane polymers of toluene diisocyanate terminatedpolyethylene glycol with less than six percent (6%) available unreactedNCO groups and a component functionality of two (2) or less.

Another urethane prepolymer is available from W. R. Grace Company of NewYork, N.Y. sold under the trademark “HYPOL 3000”. This “HYPOL” urethaneprepolymer is a polyisocyanate capped polyoxylene polyol prepolymerhaving a component functionality greater than two (2). However, thisprepolymer is formulated with a triol which reduces its hydrophiliccapability. Therefore, this “HYPOL” urethane prepolymer is lessacceptable for the formation of the base layer of the compositematerial.

When the hydrophilic urethane prepolymer is added in precise amounts tothe aqueous mixture, in addition to controlling the absorptioncharacteristics of the final composite material, it has been found thatit enhances the composite material so it can be sized and thermoformedinto three-dimensional shapes such as the insole for shoes.

Thus, in the formation of the foam layer, a given aqueous mixture willbe blended in ratios of 2 to 10 parts by weight of the aqueous mixtureto 1 part by weight of the hydrophilic urethane prepolymer. Controllingin precise amounts the relative ratio of the aqueous mixture to thehydrophilic acrylic urethane prepolymer within these limits does notimpair the capabilities of the super-absorbent polymer for absorbing andgelling moisture and body fluids with which the composite material comesinto contact.

Another form of the composite material in accordance with the presentinvention in which the cover layer, foam layer hydrophilic with respectto the cover layer and a bottom or third layer is in the form of anon-woven fiber web or felted non-woven fiber web material. In this formof the composite material, the non-woven fibers selected are preferablythose having stiffening or thermoforming capabilities.

Non-woven webs of fibrous materials for this purpose are available inthe commercial marketplace as polyester non-woven fibers coated withacrylic resin from Union Wadding of Pawtucket, R.I.; Carr Lee ofRockleigh, N.J.; Stearns Kem Wove of Charlotte, N.C.; and Loren Productsof Lawrence, Mass. Such polyester non-woven webs of fibrous material areused in the present invention because of their durability, adhesion tothe components of the respective aqueous mixtures, because they act toreduce shrinkage during the secondary drying steps in the formation ofthe foam layer for the composite material being formed as is hereinafterdescribed and because of the increase tensile strength they impart tothin films of the composite material, in accordance with the presentinvention, as those used in apparel and other products. Union Waddingsupplies such preferred non-woven fibrous webs at 11/2 to 3 ounces peryard (¼″ to ½″ thickness). These are polyester 3 and 6 denier fiberacrylic spray bonded thermoformable materials. These products areformulated to enhance thermoformability of the multi-layered composite.material.

Similarly felted non-woven webs of fibrous material are also availablein the commercial marketplace from Non Wovens Inc. of North Chelmsford,Mass., who supply their products 8 oz. per square yard, 0.080 thickness,65% low melt polyester and 35% high melt polyester. These feltednon-woven webs of fiber material provide the same improvedcharacteristics to the foam layer of the composite material inaccordance with the present invention as has been above described.

It should be noted that non-woven materials may also be introduced as acomponent of the polyurethane foam layer, rather than being bonded tothe foam layer as a discrete third layer. The addition of the non-wovenmaterial within the foam layer adds strength, minimizes shrinkage indrying and acts as a wick for moisture transpiration into the foamlayer. Such foam layers are formed by depositing the polymerizing foamonto a non-woven fiber web and compressing the foam-coated web to 10% ofits thickness, thus coating the fibers of the web with the polymerizedfoam containing interstitial voids.

In the embodiment of shoe 30 that employs wicking fabric 95, socklining41 would be obviated as wicking fabric 95 would be in contact with theuser's foot in order to wick moisture and/or odor away from the foot. Inother embodiments, socklining 41 is placed beneath bladder 60 wherebladder 60 is an insertable unit that may be interchanged with otherbladders.

In an embodiment of an orthodic device, bladder 60 is used in accordancewith certain guidelines, including Medicare requirements. Theseguidelines may change from year to year and bladder 60 and the shoe intowhich bladder 90 is inserted may change to conform to the guidelines.The following is an exemplary set of guidelines.

Therapeutic Shoes for Diabetics

HCPCS Codes

A5500—For diabetics only, fitting (including follow-up), custompreparation and supply of off-the-shelf depth-inlay shoe manufactured toaccommodate multi-density insert(s), per shoe.

A550 I—For diabetics only, fitting (including follow-up), custompreparation and supply of shoe molded from cast(s) of patient's foot(custom molded shoe), per shoe.

A5502—For diabetics only, multiple density insert(s), per shoe.

A5503—For diabetics only, modification (including fitting) ofoff-the-shelf depth-inlay shoe or custom-molded shoe with roller orrigid rocker bottom, per shoe.

A5504—For diabetics only, modification (including fitting) ofoff-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), pershoe.

A5505—For diabetics only, modification (including fitting) ofoff-the-shelf depth-inlay shoe or custom-molded shoe with metatarsalbar, per shoe.

A5506—For diabetics only, modification (including fitting) ofoff-the-shelf depth in-lay shoe or custom-molded shoe with off-setheel(s), per shoe.

A5507—For diabetics only, not otherwise specified modification(including fitting) of off-the-shelf depth-inlay or custom-molded shoe,per shoe.

L3649—Unlisted procedures for foot orthopedic shoes, shoe modificationand transfers.

Benefit Category

Therapeutic Shoes for Diabetics

Definitions

A depth shoe (A5500) is one that 1) has a full-length heel-to-toe fillerthat when removed provides a minimum of 3/16″ of additional depth usedto accommodate custom-molded or customized inserts, 2) is made fromleather or other suitable material of equal quality, 3) has some form ofshoe closure, and 4) is available in full and half sizes with a minimumof three widths so that the sole is graded to the size and width of theupper portions of the shoe according to the American standard lastsizing schedule or its equivalent. (The American last sizing schedule isthe numerical shoe sizing system used for shoes in the United States.)This includes a shoe with or without an internally seamless toe.

A custom-molded shoe (A5501) is one that 1) is constructed over apositive model of the patient's foot, 2) is made from leather or othersuitable material of equal quality, 3) has removable inserts that can bealtered or replaced as the patient's condition warrants, and 4) has someform of shoe closure. This includes a shoe with or without an internallyseamless toe.

An insert (A5502) is a total contact, multiple density, removable inlaythat is directly molded to the patient's foot or a model of thepatient's foot and that is made of a suitable material with regard tothe patient's condition.

Rigid rocker bottoms (A5503) are exterior elevations with apex positionfor 51 percent to 75 percent distance measured form the back end of theheel. The apex is a narrowed or pointed end of an anatomical structure.The apex must be positioned behind the metatarsal heads and tapering offsharply to the front tip of the sole. Apex height helps to eliminatepressure at the metatarsal heads. Rigidity is ensured by the steel inthe shoe. The heel of the shoe tapers off in the back in order to causethe heel to strike in the middle of the heel.

Roller bottoms (sole or bar) (A5503) are the same as rocker bottoms, butthe heel is tapered from the apex to the front tip of the sole.

Wedges (posting) (A5504) are either of hind foot, fore foot, or both andmay be in the middle or to the side. The function is to shift ortransfer weight bearing upon standing or during ambulation to theopposite side for added support, stabilization, equalized weightdistribution, or balance.

Metatarsal bars (A5505) are exterior bars which are placed behind themetatarsal heads in order to remove pressure from the metatarsal heads.The bars are of various shapes, heights, and construction depending onthe exact purpose. Offset heel (A5506) is a heel flanged at its baseeither in the middle, to the side, or a combination, that is thenextended upward to the shoe in order to stabilize extreme positions ofthe hind foot.

Coverage and Payment Rules

Diabetic shoes, inserts, and/or modifications to the shoes are coveredif the following criteria are met:

-   -   1) The patient has diabetes mellitus (ICD-9 diagnosis codes        250.00-250.91): and    -   2) The patient has one or more of the following conditions:        -   a) Previous amputation of the other foot, or part of either            foot, or        -   b) History of previous foot ulceration of either foot, or        -   c) History of pre-ulcerative calluses of either foot, or        -   d) Peripheral neuropathy with evidence of callus formation            of either foot, or        -   e) Foot deformity of either foot, or        -   f) Poor circulation in either foot; and    -   3) The physician who is managing the patient's systemic diabetes        condition has certified that indications 1 and 2 are met and        that he/she is treating the patient under a comprehensive plan        of care for his/her diabetes and that the patient needs diabetic        shoes.        -   For patients meeting these criteria, coverage is limited to            one of the following within one calendar year:        -   1) One pair of custom molded shoes (A5501) (which includes            inserts provided with these shoes) and 2 additional pairs of            inserts (A5502); or        -   2) One pair of depth shoes (A5500) and 3 pairs of inserts            (A5502) (not including the non-customized removable inserts            provided with such shoes).

Separate inserts may be covered and dispensed independently of diabeticshoes if the supplier of the shoes verifies in writing that the patienthas appropriate footwear into which the insert can be placed. Thisfootwear must meet the definitions found in this policy for depth shoesor custom-molded shoes. In addition, the inserts furnished must fullymeet the definition of an insert set forth in this policy. Inserts,which will be used in noncovered shoes, are noncovered.

A custom molded shoe (A5501) is covered when the patient has a footdeformity, which cannot be accommodated by a depth shoe. The nature andseverity of the deformity, which cannot be accommodated by a depth,shoe. The nature and severity of the deformity must be well documentedin the supplier's records and may be requested by the DMERC. If there isinsufficient justification for a custom molded show but the generalcoverage criteria are met, payment will be based on the allowance forthe least costly medically appropriate alternative, A5500.

A modification of a custom molded or depth shoe will be covered as asubstitute for an insert. Although not intended as a comprehensive list,the following are the most common shoe modifications: rigid rockerbottoms (A5503), roller bottoms (A5503), wedges (A5504), metatarsal bars(A5505), or offset heels (A5506). Other modifications to diabetic shoes(A5507) include, but are not limited to flared heels and inserts formissing toes.

Deluxe upgrades to diabetic shoes, including but not limited to style,color, or type of leather, will be denied as not medically necessary.

Shoes, inserts, and/or modifications that are provided to patients whodo not meet the coverage criteria will be denied as noncovered. Whencodes are billed without a ZX modifier (see Documentation section), theywill be denied as noncovered.

The particular type of footwear (shoes, inserts, modifications) which isnecessary must be prescribed by a podiatrist or other qualifiedphysician, knowledgeable in the fitting of diabetic shoes and inserts.The footwear must be fitted and furnished by a podiatrist or otherqualified individual such as a pedorthist, orthotist or prosthetist. Thecertifying physician (i.e. the physician who manages the systemicdiabetic condition) may not furnish the footwear unless he/she practicesin a defined rural area or a defined health professional shortage area.The prescribing physician (podiatrist or other qualified physician) canbe the supplier (i.e. the one who furnishes the footwear).

There is no separate payment for the fitting of the shoes, inserts ormodifications or for the certification of need or prescription of thefootwear. Unrelated evaluation and management services by the physicianare processed by the local carrier.

Coding Guidelines

Code A5507 is only to be used for not otherwise specified therapeuticmodifications to the shoe. Code A5507 is not to be used for deluxeupgrades to diabetic shoes. At this time, deluxe features should becoded using code L3649. A new HCPCS code will be established for deluxefeatures and will be published separately Therapeutic Shoes with itseffective date.

A code for inserts or modifications (A5502-A5506, A5507) may only beused for items related to diabetic shoes (A5500, A5501). They should notbe used for items related to footwear coded with codes L3215-L3253.Inserts and modifications used with L coded footwear should be codedusing L codes (L3000-L3649).

When a single shoe, insert or modification is provided, the appropriatemodifier, right (RT) or left (LT), should be used. If a pair isprovided, report as two (2) units of service on the claim—the RT or LTmodifiers should not be used.

Documentation

An order for the shoes, inserts or modifications which has been signedand dated by the prescribing physician must be kept on file by thesupplier. If the prescribing physician is the supplier, a separate orderis not required, but the item provided must be clearly noted in thepatient's record. A new order is not required for the replacement of aninsert or modification within one year of the order on file. However thesupplier's records should document the reason for the replacement. A neworder is required for the replacement of any shoe. A new order is alsorequired for the replacement of an insert or modification more than oneyear from the most recent order on file.

The supplier should obtain a signed statement from the certifyingphysician specifying that the patient has diabetes mellitus, has one ofconditions 2a-2f listed in the policy, is being treated under acomprehensive plan of care for his/her diabetes, and needs diabeticshoes. The Statement of Certifying Physician for Therapeutic Shoesdeveloped by the DMERC is recommended. This statement may be completedby the prescribing physician or supplier but must be reviewed foraccuracy of the information and signed by the certifying physician toindicate agreement. A new Certification Statement would be required fora shoe, insert or modification provided more than one-year form the mostrecent Certification Statement on file. If the supplier has a currentsigned statement on file that indicates that the coverage criteriadescribed above has been met, then a ZX modifier should be added to thecode. (ZX is a new modifier, which indicates “The specified coveragecriteria in the medical policy have been met and documentation isavailable in the supplier's records”.) A diagnosis code for diabetesshould be entered on the claim.

If code A5507 or L3649 is submitted, the claim must contain a narrativedescription of the modification or feature provided.

The prescribing physician's name and UPIN number should be listed inBlocks 17 and 17 am of the HCFA 1500 form or the electronic equivalent.

Effective Date

Coverage and Payment Rules are effective for claims with dates ofservice on or after May 1, 1993 received by the DMERC. Use of the ZXmodifier is required for claims received by the DMERC on or after Mar.1, 1995.

Attention All Miscellaneous DMEPOS Supliers:

Therapeutic Shoe Inserts—New Codes

Effective for dates of service on or after Apr. 1, 2004, the followingnew codes have been established for inserts for therapeutic shoes:

K0628 For diabetics only, multiple density insert, direct formed, moldedto foot after external heat source of 230 degrees Fahrenheit or higher,total contact with patient's foot, including arch, base layer minimum of'4 inch material of shore a 35 durometer of 3116 inch material of ShoreA 40 (or higher), prefabricated, each.

K0629 For diabetics only, multiple density insert, custom molded frommodel of patient's foot, total contact with patient's foot, includingarch, base layer minimum of 3116 inch material of Shore a 35 durometeror higher, includes arch filer and other shaping material, customfabricated, each Codes A5509 and A5511 will be invalid for claimsubmission to the Durable Medical Equipment Regional Carrier (DMERC) fordates of service on or after Apr. 1, 2004. Under the standard graceperiod, these codes will continue to be accepted on claims with dates ofservice on or after Apr. 1, 2004 that are received by Jun. 30, 2004.Claims with these codes with dates of service on or after April 2004that are received on or alter Jul. 1, 2004 will be rejected or denied asinvalid coding. Codes A5509 and A5511 should continue to be used onclaims with dates of service prior to Apr. 1, 2004 regardless of thedate of claim submission.

Suppliers should contact the Statistical Analysis Durable MedicalEquipment Regional Carrier (SADMERC) with any questions concerning thecorrect coding of specific items. Additional information concerningthese codes can be found on the SADMERC Web site, www.palmettogba.com.Select Other Partners/SADMERC, then Coding Bulletins, then New DiabeticShoe Insert Codes, A revision of the LMRP on Therapeutic Shoes forDiabetics incorporating these codes is included in the Match Region BDMERC Supplier Manual update. This article is a result of CMSPublication 100-04, Change Request 3014, dated Jan. 2, 2004.

The following examples describe various applications of bladder 60 asused in other shoes.

EXAMPLE 1 Drop-In Construction

As shown in FIG. 7, the drop-in construction shoe 102 includes footbed106, outsole 108, spacer 110 placed on top of outsole 108 for providingstructural integrity to shoe 102, and bladder 60 placed between footbed106 and spacer 110. In another embodiment, bladder 60 is placed on topof footbed 106. Alternatively, footbed 106 may be eliminated sincebladder 60 provides cushioning to the foot. Moreover, in addition tointegrity, spacer 110 provides some cushioning to shoe 102.

EXAMPLE 2 Stitch and Turn Construction

As shown in FIG. 8, the stitch and turn construction shoe 112 includesoutsole 116, insole board 117 for providing integrity to shoe 112 and alevel surface upon which the user's foot may rest, spacer 118 to raisethe user's heel to a comfortable height, and footbed 120 to cushion thefoot. Bladder 60 is thereafter placed between footbed 120 and spacer118. In another embodiment, bladder 60 is placed on top of footbed 120.In the alternative, bladder 60 may replace footbed 120 or be placedbetween spacer 118 and insole board 117.

EXAMPLE 3 Moccasin Construction

As shown in FIG. 9, the moccasin construction shoe 132 includes upper134 that extends under and around the bottom of where a user's footwould be, this part of upper 134 being called vamp 138. Outsole 140 isthen attached to a bottom of vamp 138. Optionally, cushion 142 is placedon a top of vamp 138. Socklining 139 would then be placed on top ofcushion 142 to protect cushion 142 from wear and enhance comfort to thefoot. In the event optional cushion 142 is utilized, bladder 60 isplaced between cushion 142 and socklining 139. In another embodiment,bladder 60 is placed between cushion 142 and vamp 138. In a furtherembodiment, bladder 60 is used instead of cushion 142. In the eventbladder 60 shown in FIG. 6 is employed, socklining 139 may be eliminatedin the embodiments cushion 142 is eliminated.

EXAMPLE 4 Opanka Construction

As shown in FIG. 10, the Opanka construction shoe 146 includes upper148, bladder 60, and sole 150 all handsewn together in a single sewingoperation. A socklining may also be used and sewn on top of bladder 60in the same stitching operation. In the event the embodiment of bladder60 shown in FIG. 6 is used, the socklining may be eliminated. As shown,the stitch is sewn around the entire perimeter of upper 148, bladder 60,sole 150, and the optional socklining (socklining not shown but thesocklining has the same limitations as the above described socklinings).

1. A shoe for cushioning a wearer's foot, comprising: an outsole; anupper; a bladder adapted to receive the foot and being placed betweensaid outsole and said upper; said bladder includes a first chamber and asecond chamber; said first chamber being adjacent to said second chamberfor continuous cushioning; said first chamber includes a first filler;said second chamber includes a second filler; and said first fillerbeing different than said second filler.
 2. The shoe according to claim1, said first filler being removably placed within said first chamberand said first filler having a property selected from the groupconsisting of a user determined density, a user determined volume, auser determined weight, a user determined texture, a user determinedconsistency, and combinations thereof.
 3. The shoe according to claim 1,further comprising a plurality of chambers.
 4. The shoe according toclaim 3, each chamber having a filler different from a next filler. 5.The shoe according to claim 1, wherein said first chamber is in contactwith said second chamber.
 6. The shoe according to claim 1, said bladderincludes a top sheet and a bottom sheet and said top and bottom sheetsare sealed together along a periphery of said top and bottom sheets. 7.The shoe according to claim 1, wherein said first chamber includes abaffle for inhibiting movement of said first filler.
 8. The shoeaccording to claim 7, said baffle includes a contact point between saidtop and bottom sheets within the periphery of said top and bottomsheets.
 9. The shoe according to claim 7, said baffle includes a wallwith a top end connected to said top sheet and a bottom end connected tosaid bottom sheet.
 10. The shoe according to claim 7, said baffle is apermeable membrane.
 11. The shoe according to claim 1, wherein saidbladder extends from a toe area to a heel area and from a left side to aright side.
 12. The shoe according to claim 1, wherein said outsoleextends from a toe area to a heel area and from a left side to a rightside.
 13. The shoe according to claim 12, wherein said bladder extendsfrom said toe area of said outsole to said heel area of said outsole andfrom said left side of said outsole to said right side of said outsole.14. The shoe according to claim 10, wherein said membrane extends from atoe area to a heel area and from a left side to a right side.
 15. Theshoe according to claim 12, wherein said membrane extends from said toearea of said outsole to said heel area of said outsole and from saidleft side of said outsole to said right side of said outsole.
 16. A shoefor cushioning a wearer's foot, comprising: an outsole; an upper; abladder adapted to receive the foot and being placed between saidoutsole and said upper; said bladder includes a first chamber and asecond chamber; and said first chamber being in contact with said secondchamber for providing continuous cushioning.
 17. The shoe according toclaim 16, further comprising a first filler removably placed within saidfirst chamber and said first filler includes a property selected fromthe group consisting of a user determined density, a user determinedvolume, a user determined weight, a user determined texture, a userdetermined consistency, and combinations thereof.
 18. The shoe accordingto claim 16, the shoe further comprising a baffle within said firstchamber.
 19. The shoe according to claim 16, further comprising asocklining placed on top of said bladder adapted to receive a wearer'sfoot.
 20. The shoe according to claim 16, wherein a distance betweensaid first and second chambers is fixed.
 21. The shoe according to claim16, wherein said first chamber is adjacent to said second chamber. 22.The shoe according to claim 16, further comprising a plurality ofchambers and a plurality of fillers, each filler corresponding to eachchamber.
 23. A shoe for cushioning a wearer's foot, comprising: anoutsole; an upper; a bladder adapted to receive the foot and beingplaced between said outsole and said upper; said bladder includes aplurality of chambers, each chamber of said plurality of chambers beingadjacent to a next chamber; and a plurality of fillers corresponding tosaid plurality of chambers, each filler of said plurality of fillersbeing different than a next filler.
 24. The shoe according to claim 23,wherein said bladder is removably placed between said upper and saidoutsole.
 25. The shoe according to claim 23, wherein said bladder isintegrally placed between said outsole and said upper.
 26. A bladder,comprising: a top sheet having a periphery; a bottom sheet having aperiphery; said top sheet in contact with said bottom sheet along saidperipheries of said top and bottom sheets; and said top sheet is incontact with said bottom sheet in a localized area for defining a firstchamber and a second chamber.
 27. The bladder according to claim 26,wherein said localized area extends across said top and bottom sheetsfrom one side to an opposite side.
 28. The bladder according to claim26, wherein said first chamber includes a baffle for inhibiting movementof said first filler.
 29. The bladder according to claim 28, said baffleincludes a contact point between said top and bottom sheets within saidperipheries of said top and bottom sheets.
 30. The bladder according toclaim 26, wherein said first chamber is in contact with said secondchamber.
 31. The bladder according to claim 26, wherein said firstchamber includes a first filler and said second chamber includes asecond filler, wherein said first filler is different than said secondfiller.
 32. The bladder according to claim 26, further comprising aplurality of chambers, each chamber of said plurality of chambers beingadjacent to a next chamber, and a plurality of fillers corresponding tosaid plurality of chambers, each filler of said plurality of fillersbeing different than a next filler.
 33. A shoe for cushioning a wearer'sfoot, comprising: an outsole; an upper; a bladder adapted to receive thefoot and being placed between said outsole and said upper; said bladderincludes wicking material; said bladder includes a first chamber and asecond chamber removably attached to said wicking material; said firstchamber being adjacent to said second chamber for continuous cushioning;said first chamber includes a first filler; said second chamber includesa second filler; said first filler being different than said secondfiller; said first filler is integrally connected with said firstchamber to form a single unit; and said second filler is integrallyconnected with said second chamber to form a single unit.
 34. The shoeaccording to claim 33, said first filler and said first chamber are bothremovably attached to said wicking material and said first filler andsaid first chamber have a property selected from the group consisting ofa user determined density, a user determined volume, a user determinedweight, a user determined texture, a user determined consistency, andcombinations thereof.
 35. The shoe according to claim 33, furthercomprising a plurality of chambers.
 36. The shoe according to claim 35,each chamber being different from a next chamber.
 37. The shoe accordingto claim 35, wherein said first chamber is in contact with said secondchamber for providing continuous cushioning.
 38. The shoe according toclaim 35, wherein said first chamber is adjacent to said second chamber.